California Form 3760 - Withholding Order Payment Voucher For Individuals
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1Instructions for Form FTB 3760
Withholding Order Payment Voucher for Individuals
What’s New
B Instructions
A separate payment voucher and check must be used for each
Electronic Bank Levy Program (eLevy) – California Revenue and
individual taxpayer. Enter all information requested using black or
Taxation Code (R&TC) Section 18670.5 grants the Franchise Tax
blue ink.
Board (FTB) authority to serve Order to Withhold (OTW) notices
by magnetic media, electronic transmission, or other electronic
To ensure timely and proper application of the payment to the
technology to financial institutions.
taxpayer’s account, enter the individual’s and spouses/RDP’s (if
applicable) name, address, social security number (SSN), and the
amount of payment in the designated spaces. Enter the amount
General Information
of payment with dollars and cents. The information on form
The eLevy program allows the FTB to electronically issue OTW
FTB 3760 should match the information as it appears on the OTW
notices. Financial institutions can make payments for OTW
notice that was received from the FTB.
notices received by using the voucher below, along with a check,
Using black or blue ink, make your check payable to the
or payments can be electronically submitted via the Electronic
“Franchise Tax Board.” Enter the SSN and “FTB 3760” on the
Funds Transfer (EFT) program. For more information about EFT,
check. Make all check(s) payable in U.S. dollars and drawn
go to ftb.ca.gov and search for eft.
against a U.S. financial institution.
If remitting payment by mail, form FTB 3760, Withholding Order
Private Mail Box (PMB) – Include the Private Mail Box (PMB)
Payment Voucher for Individuals, must be included with your
in the address field. Write “PMB” first, then the box number.
OTW tax payment. To register for the eLevy program, which
Example: 111 Main Street PMB 123.
allows you to use this voucher, go to ftb.ca.gov and search for
Foreign Address – Enter the information in the following order:
elevy.
City, Country, Province/Region, and Postal Code. Follow the
country’s practice for entering the postal code. Do not abbreviate
A Purpose
the country name.
Use form FTB 3760, along with your payment, to remit your OTW
tax payment to the FTB. Do not use form FTB 3760 if remitting
C Where to File
OTW tax payments electronically.
Multiple payments and vouchers can be mailed in the same
envelope. Detach the payment voucher from the bottom of
the page and enclose, but do not staple, the payment with the
voucher and mail to:
FRANCHISE TAX BOARD
PO BOX 942867
SACRAMENTO CA 94267-0031
IF NO PAYMENT IS DUE, DO NOT MAIL THIS FORM
DETACH HERE
DETACH HERE
CALIFORNIA FORM
3760
Withholding Order Payment Voucher for Individuals
Individual’s first name
Initial
Individual’s last name
SSN
Spouse’s/RDP’s first name (If applicable)
Initial
Spouse’s/RDP’s last name
Spouse’s/RDP’s SSN
Address (number and street, PO Box, or PMB no.)
Apt. no./Ste. no.
City (If you have a foreign address, see instructions)
State
Zip Code
Make check payable to: “Franchise Tax Board.” Write the individual’s social security number
and “FTB 3760” on the check.
Amount of payment
Mail this form and your check to:
FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0031
.
,
,
FTB 3760 (NEW 03-2013)
8371133
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